the tweed profile - The Charles H. Tweed International Foundation

Cephalometrically, there was a good skeletal pattern, a
good maxillo-mandibular relationship and angulations
of teeth. Occlusal plane and Z angle were ideal (Fig
4).
DIAGNOSIS AND TREATMENT PLANNING
The cranio-facial analysis revealed no skeletal problem
and Merrifield´s total space analysis indicated
space requirements in the anterior and posterior area.
The total difficulty score was only 29. Orthodontic
treatment was planned. The extraction of maxillary
and mandibular first premolars and all third molars
was indicated.
This patient’s malocclusion correction serves as a
good example of how Tweed-Merrifield directional
force technology can help the clinician achieve a good
result regardless of the space severity. However, it is
important to summarize some issues that were relevant
during the correction of this treatment:
a. Maintenance of arch form and archwire coor-
dination
b. The use of proper directional forces
c. Second order bends – good and efficient an-
chorage preparation
d. Leveling and reshaping anterior teeth
Fig 4
Fig 5
Periodontal concerns were also considered. The periodontist
recontoured both gingival and alveolar bone
margins to a more ideal level after the anterior teeth
were leveled and Bolton discrepancies eliminated.
Since the patient presented with severe anterior crowding,
the periodontist also did a supracrestal fiberotomy
from premolar to premolar in both arches three months
prior to the removal of orthodontic appliances. The
patient was periodically examined during orthodontic
treatment to evaluate oral hygiene and tissue conditions
(Figs 5 and 6).
Figure 7 shows changes in the gingival outline of the
anterior teeth before and after treatment.
Fig 6
RESULTS
The face shows harmony and balance. The smile line
and buccal corridors have improved as has the noselip-chin
spatial relationship (Fig 8).
Teeth and gingiva are healthy and esthetic. Good “architecture”
of the gingival complex is evident (Fig 9).
Fig 7
A Class I occlusion was maintained along with proper
canine guidance. The maxillary arch has harmony in
shape and proportion of the teeth because the Bolton
discrepancy was eliminated. The mandibular arch
shows nice dental alignment. The occlusal plane was
controlled while overbite and overjet were overcor-
Fig 8
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